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Is reducing t4 (Levoxyl) as Dr. advises the right course of action.
I am currently on 50 Levoxyl & 25 Cytomel. Recent labs:
TSH: 0.02 (0.40-4.50)
T4, Free: 0.9 (0.8-1.8 ng/dL)
T3, Free: 3.2 (2.3-4.2 pg/mL)
TPO: 11 (<9IU/mL) H
He wants to decrease the Levoxyl to 25 mcg. I am concerned there will be increased fatigue, and/or weight gain.
TSH: 0.02 (0.40-4.50)
T4, Free: 0.9 (0.8-1.8 ng/dL)
T3, Free: 3.2 (2.3-4.2 pg/mL)
TPO: 11 (<9IU/mL) H
He wants to decrease the Levoxyl to 25 mcg. I am concerned there will be increased fatigue, and/or weight gain.
You are right to be concerned that a dose decrease will worsen your hypo symptoms. Your doctor is reacting to the erroneous belief that TSH suppression automatically means hyperthyroidism. In reality a suppressed TSH does not mean hyperthyroidism unless you have hyper symptoms due to excessive levels of Free T4 and Free T3, which you do not have. There are also studies confirming that when taking adequate doses of replacement thyroid medication, TSH frequently becomes suppressed.
If you are still having hypo symptoms, then the doctor should be increasing your T4 med to get your Free T4 to the middle of the range, at minimum, and your Free T3 should be increased enough to relieve hypo symptoms.
I suggest that you should give a copy of this link to your doctor and request that your meds be increased as outlined above, in order to relieve hypothyroid symptoms. Any misgivings that the doctor has can be alleviated by reading the paper and reviewing all the supporting scientific evidence.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
If you are still having hypo symptoms, then the doctor should be increasing your T4 med to get your Free T4 to the middle of the range, at minimum, and your Free T3 should be increased enough to relieve hypo symptoms.
I suggest that you should give a copy of this link to your doctor and request that your meds be increased as outlined above, in order to relieve hypothyroid symptoms. Any misgivings that the doctor has can be alleviated by reading the paper and reviewing all the supporting scientific evidence.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
It is very common for someone on T3 medication (Cytomel) to have the TSH suppressed.
The fact that this Dr doesn't know that would be a reason in my mind to look for another Dr. Combined with your note that the endo has previous bad history with you is just another nail in the coffin.
Your FT4 is 10% of the range and the rule of thumb is 50%
Your FT3 is at 47% and the rule of thumb is 50% to 67% of the range.
if you still have symptoms of low thyroid, I would recommend just the opposite of what your Dr is suggesting.
Did you take your T3 medication prior to getting the blood drawn? If so, that could or most likely will cause a false high result.
Do you take your T3 in a split dose? Taking half in the morning and the other half in the early afternoon? If not, I would recommend that as well.
T3 ramps up quickly in your blood. As it reaches peak levels about 4 hours after taking it, and is mostly gone by about 8 hours after taking it. By taking half in the morning and half in the afternoon, it helps level out the amount in your blood. The 2nd dose is ramping up, while the first dose is waning away.
The fact that this Dr doesn't know that would be a reason in my mind to look for another Dr. Combined with your note that the endo has previous bad history with you is just another nail in the coffin.
Your FT4 is 10% of the range and the rule of thumb is 50%
Your FT3 is at 47% and the rule of thumb is 50% to 67% of the range.
if you still have symptoms of low thyroid, I would recommend just the opposite of what your Dr is suggesting.
Did you take your T3 medication prior to getting the blood drawn? If so, that could or most likely will cause a false high result.
Do you take your T3 in a split dose? Taking half in the morning and the other half in the early afternoon? If not, I would recommend that as well.
T3 ramps up quickly in your blood. As it reaches peak levels about 4 hours after taking it, and is mostly gone by about 8 hours after taking it. By taking half in the morning and half in the afternoon, it helps level out the amount in your blood. The 2nd dose is ramping up, while the first dose is waning away.
Thank you, gimel. I've tried to explain to himthe tsh is irrelevant. I am forced to see a dr., out of network. This current endo has been making things worse for me. The Armour dosage he prescribed decreased my t3 by nearly 60%! I am currently experiencing a flu like sickness, I expect a result of all this.
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